Apply Now DUROFAST TRADE CREDIT APPLICATION Registered Legal Entity Name Main Trading Name ABN ACN Date of Incorporation Nature of Business Business Structure Trading Address Postal Address Phone Email Accounts Payable Contact Full Name Phone Email Receive monthly statements via Email Post Purchasing Contact Full Name Phone Email Order number required Yes No Director/ Principle Details ID (Drivers Licence) required for each individual of Partnerships/ Sole Trader/ Individual Trustee of Trusts - Please attach a photocopy of each applicant. Family Name First Name Residential Address DOB I/ we declare the above facts to be true in every respect and apply to open a 30 day Trade Credit Account with Durofast for approximately $ per month and 1/ we agree to abide by Durofast’s Terms and Conditions of Sale as attached. Should a Credit Limit be granted, I/we undertake to settle the account strictly within 30 days from the end of the month of purchase. If the Applicant is a company, I/we warrant that I/we am/ are duly authorised to act on behalf of the Applicant, and further understand and agree that by signing below I/we will be personally bound by these terms and conditions and guarantee any debts or other amounts owed by the Applicant to Durofast. Applicant Agreement (all applicants to sign - copy page if required) Signature Date Name Position/ Title Signature Date Name Position/ Title Signature Date Name Position/ Title Office Use: Received by Consultant Date I accept terms and conditions and general policy.